Survey Finds Cerebral Palsy More Frequent in Uganda than in High-income Countries

Survey Finds Cerebral Palsy More Frequent in Uganda than in High-income Countries
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Cerebral palsy is more frequent and has higher mortality rates in Uganda than in high-income countries. The underlying brain injury that takes place during early infancy is likely caused by cerebral malaria, according to researchers from Karolinska Institutet in Sweden and Makerere University in Uganda.

Researchers from the two institutions conducted a population-based study titled, “Prevalence of cerebral palsy in Uganda: a population-based study,” published in The Lancet Global Health.

Data collected from several studies have shown that about 10 percent of all children in high-income countries have some type of neurodevelopmental disorder, and two in every thousand children have cerebral palsy. Support programs and improved treatment and care strategies are vital for this patient population. However, similar information is lacking for low- and middle-income countries.

To better understand the situation in Uganda, in sub-Saharan Africa, researchers used the Iganga-Mayuge Health and Demographic Surveillance System (IMHDSS) to screen for cerebral palsy in children ages 2–17 in a rural eastern district of the country. The project was supported by the Swedish International Development Cooperation Agency.

“Children with developmental disabilities are neglected and discriminated against in many countries, where they live under difficult circumstances,” Hans Forssberg, a professor in the Department of Women’s and Children’s Health at Karolinska Institutet and senior author of the study, said in a university news release. “A first step towards changing this is to show that children with disabilities exist and how common different neurodevelopmental conditions are.”

Researchers used data from an IMHDSS surveillance round from March 1, 2015, to June 30, 2015. A total of 31,756 children were screened for cerebral palsy, which was confirmed in 86 of 442 children who screened positive in the first screening stage. Cerebral palsy prevalence was 2.9 per thousand children and was lower in the older age range (8–17 years) than in the younger one (under 8). These numbers mean that cerebral palsy in children ages 2-17 is 50 percent more common in Uganda than in high-income countries.

“We interpret this as due to high mortality, particularly for children with severe functional disabilities. The incidence of cerebral palsy is therefore probably twice as high in Uganda as in HIC [high-income countries],” Forssberg said. “Our findings on increased mortality need to be followed up in a longitudinal study, and if corroborated, the new knowledge must lead to better care of children with cerebral palsy.”

In contrast to high-income countries, where 40 percent of cases of cerebral palsy are linked to preterm births, in Uganda, only 2 percent of children with this condition are born preterm, likely due to the low survival rate of preterm infants in the rural areas of the country.

“This is important to consider now when programmes are initiated to increase survival rate of preterm born infants,” Forssberg said. “It’s important that the brain is protected to prevent surviving infants from developing cerebral palsy.”

Of note, post-neonatal events were the probable cause of cerebral palsy in 24 of 97 children (25 percent). According to the caregivers’ reports, these children had a normal clinical history after birth until they suddenly became ill with fever and seizures followed by chronic motor impairments.

The researchers suggest that these events could be due to cerebral malaria, which is endemic in the area and could be addressed with preventive measures or better treatment.

“This information will be important to increase public awareness and to develop national health programmes and international initiatives for children with neurodevelopmental disorders,” the team concludes in their report.

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